Provider Demographics
NPI:1265689780
Name:HULL, CHERYL BETH (MS, RD/LD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BETH
Last Name:HULL
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 S 143RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5722
Mailing Address - Country:US
Mailing Address - Phone:918-813-2800
Mailing Address - Fax:918-949-6678
Practice Address - Street 1:3805 S 143RD EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-5722
Practice Address - Country:US
Practice Address - Phone:918-813-2800
Practice Address - Fax:918-949-6678
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered